Tonic-clonic seizure: what it looks like and what to do

A tonic-clonic seizure (often called a grand mal) is one of the most dramatic seizure types. It usually starts with a stiffening phase (tonic) where the person goes rigid, then a convulsive phase (clonic) with jerking movements. Consciousness is lost during the event, and afterward people often feel confused, sleepy, or sore. Knowing the signs and basic first aid can make a huge difference.

Recognizing a tonic-clonic seizure

Typical signs include sudden collapse, rigid body, rhythmic jerking of arms and legs, irregular breathing or brief breathing pauses, and loss of bladder or bowel control. The active part usually lasts under two minutes, but the recovery (the postictal state) can last minutes to hours with confusion, tiredness, or headache. If this is the person’s first seizure, treat it seriously and seek medical follow-up.

Common causes range from epilepsy and brain injury to metabolic problems (like very low blood sugar), infections, high fever in children, withdrawal from alcohol or sedatives, and some medications or drug interactions. Doctors use EEG, brain imaging (MRI/CT), and blood tests to find the cause and guide treatment.

What to do—and what not to do—during a seizure

Time the seizure. If it lasts more than 5 minutes, call emergency services right away—prolonged seizures can be dangerous. Clear the area so the person won’t hit furniture. Cushion their head and gently turn them onto their side once the jerking stops to help keep the airway clear. Loosen tight clothing around the neck.

Do not restrain their movements or put anything in their mouth. Don’t try to force food, drink, or medication while they’re unconscious. When they wake, speak calmly and let them rest. Offer water only after they’re fully alert and swallowing normally.

If the person is pregnant, injured, diabetic, having difficulty breathing after the seizure, or it’s their first seizure, call medical help right away. Also call if seizures happen back-to-back, or if a rescue medication (like rectal diazepam or intranasal midazolam) is needed and available.

Long-term management focuses on the underlying cause. Anti-seizure medications commonly used include valproate (Depakote), carbamazepine, phenytoin, levetiracetam, and others—your doctor will pick the best option based on the diagnosis and side effects. For some people, lifestyle measures (regular sleep, avoiding alcohol, treating low blood sugar) plus a seizure action plan, medical ID, and emergency rescue meds make daily life safer. In selected cases, surgery, ketogenic diet, or devices like VNS can be options.

Make a plan with your healthcare provider: know triggers, keep follow-up tests, and practice first-aid steps with friends or family. Practical preparation and the right care reduce risks and help people with tonic-clonic seizures live fuller, safer lives.